Dr Chris Lancelot: Save the money for the important things

By Chris Lancelot on the
26 September 2008

'There's always time enough for the important things,' wrote Alan Lakein. And since in a viable enterprise time and money are interchangeable, it follows that there is money enough for the important things, too.

It all depends upon priorities. The NHS currently gets through £110 billion a year - an enormous amount by anyone's standards. Despite this, there never seems enough for the truly important stuff such as anti-cancer drugs. Oncologists have been objecting to the way in which many antineoplastics available in other countries are currently excluded from NHS-use on the grounds of cost-effectiveness.

But there is money enough for the important things ... isn't there? It depends on whose definition of 'important' you accept. If we regard the NHS as an all-encompassing healthcare system, free at the point of need, then the priority is for patients to receive the treatment they need when they need it.

The exclusion of these anti-cancer medications implies that those making choices about what is important are not doctors - as indeed they aren't. What are managers' priorities? Here is what really does get top-sliced: money for administration, managers' buildings and more managers. The rest - if there is anything left - can be spent on the patients. That's why, in an NHS that, clinically, has always been strapped for cash, Quarry House in Leeds was treated to a hand-woven carpet looking like a flowing stream. It must have cost a bob or two: totally unnecessary, but doubtless very impressive.

What about the renaming of PCTs from 'Local PCT' to 'NHS Local'? A small change, but the nationwide cost of wasted stationery could have bought many medical interventions. There would be even more money for therapy if we ditched the private finance initiative, practice-based commissioners and SHAs, and drastically pruned Connecting for Health. Remember: every superfluous manager, unnecessary administrative procedure and unnecessary or over-specified building takes money and time away from the important things.

If the NHS resolved to spend its money first on the things that really mattered - medicines, operations and front-line staff - there would be enough to spare.